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Injury Prevention for Field Hockey

Injury Prevention for Field Hockey

Injury is a common problem in hockey, with over half of all female hockey injuries occurring in the lower limb and over a third of total injuries being ankle sprains (Murtaugh, 2001). Due to the asymmetrical positions, low shapes, and rotational nature of the sport, it places high amounts of stress on specific tissues and joints, which unless mitigated may lead to significant time loss.

The best ability is availability

One of the primary issues that injury causes is the reduced availability of our best players. It could be argued that the most important factor in determining sporting success is the availability of the best athletes for the key moments in games and tournaments. This is why one of the most important philosophical cornerstones of my approach is the ‘hierarchy of needs’ model, whereby there is a heavy emphasis on developing robustness before anything else. In its simplest form, this hierarchy enables faster, informed decisions around the priorities for a given athlete, supported by objective data.

This is particularly important when there is a low squad number, poor squad depth, or we are involved in a lot of tournament hockey. In effect, by focussing on downside risk mitigation before upside performance enhancement, we maximise the preparedness and availability of our best players for the key moments that matter.

Next let’s look at a few simple tests that we can complete that involve little to no equipment, but which can provide us with actionable insights into injury risk profile. These are the calf capacity test, the hamstring bridge capacity test, and the single-leg hop test.

Although not ‘predictive’ in the truest sense, they at least allow us to tick off boxes when seeking to gain information that aids the decision-making process around physical preparation and injury prevention. If we know that an athlete has met all of the capacity markers for the key injury sites, then we can move on to look at other physical qualities. If they haven’t, then we can continue to make this a key priority in the hierarchical model already outlined.

Calf capacity test

Ankle sprains are a very common injury in the sport, but by ensuring adequate capacity of the calf musculature, dorsiflexion range of motion, asymmetry scores, tibialis anterior strength (Naicker et al., 2007), and peak plantarflexion force, we can offset the risk of ankle sprains which account for such a high proportion of total injuries.

A simple calf capacity test can be a useful parameter of basic capacity of the calf/soleus complex to withstand repeated loading.

The protocol is as follows:

  • This test assesses single-leg strength of the calf and soleus primarily, as well as assessing limb asymmetry and capacity

  • Start a metronome at 60bpm, and use this to guide your tempo throughout the test (1 second up, 1 second down)

  • On one leg, raise up onto the balls of your feet

  • Control down to full range

  • Finger tips from each hand allowed on the wall but not assistance allowed from upper body

  • Common reasons for stopping: rolling the ankle, ‘hitching the hip’, not achieving full range of motion, muscular fatigue

  • One technical deviation allowed max

  • Repeat until repetition failure or any pain is experienced (important)

  • Score is total reps achieved

A study by Herbert-Losier et al (2017) found the following normative values for male and females:

  • 20-29yrs: Males 37 reps, Females 30 reps

  • 30-39yrs: Males 32, Females 27

  • 40-49yrs: Males 28, Females 24



Hamstring capacity test

The hamstring is a risk area in field hockey owing to the low positions which places the hamstring under more relative load (due to greater hip flexion). It also involves a high amount of high-speed decelerations, which are particularly demanding on the hamstrings.

This test assesses single-leg strength of the hamstrings and glutes primarily, as well as assessing limb asymmetry and capacity. We know that hamstring capacity is related to previous hamstring injury, and may be a useful screening tool to identify ‘at risk’ athletes for future injury.

The protocol is as follows:

  • Start a metronome at 60bpm, and use this to guide your tempo throughout the test (1 second up, 1 second down)

  • Common reasons for stopping: back begins to over work, cramp, foot slides away on box, not achieving full range of motion, muscular fatigue

  • Repeat until repetition failure or any pain is experienced (important)

  • One technical deviation allowed max

  • Score is total reps achieved

Freckleton et al. (2014) outlined the following norms which were in agreement with existing research: <20 = poor, 25 = average>30 = good. Those who had existing hamstring injuries were more likely to score in the poor category.



Single leg hop test

As already mentioned, the lower limb is the most common injury in hockey, accounting for over 50% of all injuries. Not only that, but asymmetry is a risk factor for future injury, and the ankle is a key injury risk site in the sport. With these things in mind, screening athletes for single-leg landing, control and stability has significant merit.

This test assesses single leg control and stability and is a reliable test (Dingenen et al., 2019).

The aim is to hop forwards as far as possible, whilst sticking the landing effectively.

The protocol is as follows:

  • On one leg, hop forwards sticking the landing

  • Take a measurement from the start line to the back of the heel

  • Repeat x 3 on each side, alternating sides for each effort

  • If the first effort is significantly lower than the other two, repeat one more time

  • Score is average (mean) of 3 efforts

N.B. if the coefficient of variation (CV) is higher than 10% then complete a fourth repetition on the relevant side and disregard the anomaly.



Summary

In conclusion, injury is a problem that limits playing time for athetes. This is particularly problematic when it affects the best players in the side, who are likely to contribute significantly to the performance outcome. By focussing on downside risk mitigation before upside performance enhancement, we can increase playing availability and overall performance. These three tests are simple, reliable measures that we can use to screen hockey players to flag potential risks. Once these boxes have been ticked off, we can focus our efforts on other physical qualities that may have a bigger performance impact.

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Henry

 

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